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This Week in the Legislature: Health & Human Services

This week in the Legislature, the Senate finally released its proposal for transitioning counties from a claims-based Medicaid cost-sharing relationship with the state to a formula-based approach. SB 1884, which came out of Senate Health Policy, would require counties to pay fixed amounts annually based on their respective percentages of Medicaid enrollees. While FAC understands that using objective data, such as Medicaid enrollment, may provide for better budgeting predictability and eliminate administrative costs, the methodology also results in significant swings in growth on a county-by-county basis. FAC staff continues to work with the House and Senate on alternatives. FAC has done an analysis of the bill, which can be found here.

Summary: SB 1884 replaces the existing county-state Medicaid cost-sharing relationship, which requires the counties to reimburse the state for a share of certain inpatient hospital days and nursing home costs, with a fixed, formula-based county contribution. Specifically, the bill:

Sets a total FY 2013-14 county contribution base amount of $269.6M, which is the REC’s estimate for medical hospital fee revenues (i.e. county Medicaid contributions in s. 409.915, F.S.).

Provides that the FY 2013-14 base amount would be adjusted annually in proportion to the percentage change in state Medicaid expenditures. In other words, if the state Medicaid expenditures grow 10%, the county contribution would grow 10%.

Bases individual county contribution shares, as percentages, on Medicaid enrollment by county. This formula results in significant swings in growth from the current year to FY 13-14 among the counties, ranging from negative 30% to 170%.

Allows for counties to pay their contributions in equal monthly installments, by the 5th day of each month; DOR is directed to reduce a county’s half-cent sales tax distribution in the event that the county does not remit payment by the 5th day of the month.

Status: SPB 7156 was considered in Senate Health Policy on April 16. Although the committee voted unanimously to introduce the bill, several members expressed concern over the financial impacts on their respective counties. Sen. Grimsley, who is carrying the bill, committed to working with the counties to address these concerns. SPB 7156 was filed as SB 1844, and has been referred to the Appropriations committee. The agenda has not yet been set, but FAC expects SB 1884 to be considered by committee on Tuesday, April 23.

Clarifies and updates the statutes relating to unclaimed and indigent burials

Provides that counties may adopt policies and procedures for the final disposition of unclaimed human remains

Authorizes counties to make final disposition of unclaimed human remains under certain circumstances

New language (from last year): allows certain veterans organizations to assist with recovery and interment of unclaimed cremated remains of veterans

Status: HB 171 passed the full House unanimously and is now in Senate messages. SB 370 passed its third committee, Senate Judiciary, unanimously, and has only one remaining committee stop before moving to the Senate floor.

Outlook: The bills have support from various stakeholders, including the counties, Department of Veterans Affairs, and funeral industry representatives. FAC is extremely pleased to see HB 171 pass in the House so early in the Legislative Session. SB 370 continues to move and has received no opposition thus far.

Currently, sec. 386.209, F.S. preempts the regulation of smoking to the state, except that school districts can further restrict smoking on school district property.

Bills would remove counties and cities from the preemption, allowing them to further restrict smoking on certain county or municipal outdoor property if they choose do to so by local ordinance.

Status:

SB 258 passed unanimously in Senate Regulated Industries, amended to specify the locations where local governments can restrict smoking as well as the processes for enforcing local smoking ordinances. Additionally, non-smoking areas would have to be clearly defined, and designated smoking areas would be required.

SB 258 passed 6-3 in Senate Health Policy. The bill allows a city or county to require, as a condition for a lease on property that it owns or controls, that smoking be prohibited on the property; however, it was amended in Senate Health Policy to provide that such a restriction may not apply to a pre-existing lease, including a lease renewal, without the lessee’s consent.

The plan is an alternative to Medicaid expansion pursuant to the Affordable Care Act (ACA), but relies on the same federal dollars for funding. Federal approval would be required in order for the state to gain access to these funds.

Enrollees would be offered choices of plans, which would be required to cover certain services and provide health savings accounts. Enrollees would have to meet certain cost-sharing requirements based on their income, which could be as low as $3 or $4 co-pays.

Plans would be required to meet an 85 percent medical loss ratio.

Status:SPB 7038 was introduced as a committee bill, SB 1816, and referred to the Health and Human Services Appropriations and full Appropriations committees.

Summary: Creates the Health Choice Plus (HCP) program to offer a health benefits program for uninsured persons ages 19 to 64 who fall below 100 percent of the federal poverty level but are not otherwise eligible for Medicaid. The program would be managed and administered by the existing Florida Health Choices Corporation.

Health benefits accounts provided to enrollees would be jointly funded by the recipients and the state (subject to annual appropriations) and would not rely on the federal funds made available to Florida under the ACA.

Funds deposited into health benefits accounts could be used by the account holder to offset health care costs or purchase health care services from the marketplace.

The bill has an estimated fiscal impact of $15,275,000 for SFY 2013-14.

Status:SB 1844 passed out of the Senate Appropriations Subcommittee on Health and Human Services on a 7-4 vote, and is now in the full Appropriations committee.

Summary: Creates the Florida Health Choices Plus Program within the Florida Health Choices Program, to assist certain uninsured persons between ages 19 to 64 who fall below 100 percent of the federal poverty level but are not otherwise eligible for Medicaid, The program would be managed and administered by the existing Florida Health Choices Corporation.

Similar to SB 7144 (by Sen. Bean/Health Policy Committee), the accounts provided under the plan would be jointly funded by the state and enrollees, and would not rely on the federal funds made available to Florida under the Affordable Care Act.

The program would provide CARE accounts (contribution amount for responsible expenditures) to enrollees. Each enrollee would receive $2000 in his or her CARE account, subject to annual appropriation, to purchase health coverage products and services available in the marketplace. To maintain eligibility, enrollees would be required to contribute $25 per month into their individual CARE accounts.

The plan would have a fiscal impact of $11.9M in FY 2014, although the plan would not be launched until late in the fiscal year (April 2014). The fiscal impact is estimated to be $120M in FY 2015, rising to $266M in FY 2023.

Status: PCB-SPPACA3 passed in the House Select Committee on Patient Protection and Affordable Care Act on a 11-6 vote, and filed as HB 7169. The bill is now on the House Appropriations agenda for April 19. The proposal, which is the House’s version of a Florida-specific, Medicaid-expansion alternative, is similar Sen. Bean’s plan in that does not utilize federal dollars. In response to the House plan being unveiled, Governor Scott released a statement expressing his continued support for a proposal that utilizes the federal ACA funds available to Florida.